MED治疗腰椎间盘突出症时对神经根变异的探查

目的：观察显微内窥镜下椎间盘切除术（microendoscopic discectomy，MED）治疗腰椎间盘突出症时神经根变异情况，防止出现术中神经根损伤。方法：回顾分析自1999年10月至2003年12月应用MED治疗的腰椎间盘突出症患者724例，其中男452例，女272例。对术中发现存在腰骶神经根变异患者的临床特点及术中所见进行统计分析。结果：724例腰椎间盘突出症患者有37例神经根变异，发生率为5.1％。与术前的临床表现吻合，全部神经根变异患者均在MED下完成手术，无一例出现神经根损伤。结论：仔细探查及分离突出髓核周围神经根发出情况．确定有无神经根变异是防止MED治疗腰椎间盘突出症时发生神经根损伤的重要环节之一。     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

胆囊切除术的技术改进

目的：探索更好的胆囊切除术的方法。方法：我们对近2年收治的100例胆囊切除术的病人手术作了一些技术改进，包括：右肋缘下斜切口（4－6cm)，不切断腹直肌，胆囊管和胆囊动脉分别用钛夹夹闭，不行腹腔深部打结，剥离胆囊床前将胆囊内胆汁抽空，用电刀剥离胆囊边切边止血，不缝合胆囊床，结果：腹部切口小、创伤轻、恢复快，在直视下操作安全可靠。结论：是一个较好的临床胆囊切除方法，患者易接受。     

纳洛酮的临床应用及不良反应的探讨

本文阐述纳络酮药动学、临床应用及不良反应.     

B型肉毒毒素在美容领域的应用进展

肉毒毒素(botulinum Toxin,BT)是由革兰氏阳性、产孢、厌氧性肉毒杆菌(clostridiumbotulinum)产生的外毒素[1]。一个多世纪前,它首先被描述为肉毒中毒,这是在食用腐败腊肠后发生的严重神经性疾病。而最近这种致病因子被作为治疗工具用于大量的神经紊乱性疾病。根据其抗原性不同,肉毒毒素分为A、B、C(C1和C2)、D、E、F、G7个血清型[2]。所有的这七种血清型的肉毒毒素都是作用于神经肌接头起作用,它们和相关的特异性蛋白作用,从而抑制肌肉收缩和发汗所必需的乙酰胆碱向神经肌接头处的释放,导致被注射肌肉的瘫痪和变弱。目前,在美国市场有…     

缺血性脑血管病患者颈动脉超声检查的临床意义

目的　评价颈动脉超声检查在缺血性脑血管病的临床意义。方法　对 131例缺血性脑血管病患者行颈动脉超声检查 ,并检查 4 0例同期住院的非心脑血管病患者作对照。结果　缺血性脑血管病组颈总动脉内膜 中层厚度 (IMT)与颈总动脉内径与对照组有明显差异 (P <0 0 0 1) ,老年组IMT显著高于 <6 0岁组(P <0 0 0 1)。缺血性脑血管病组颈动脉粥样斑块的发生率为 6 4 9% ,斑块好发于颈总动脉分叉处及颈内动脉入口和起始处 (84 8% ) ,以低回声斑块为主 (6 1 4 % ) ,其次为强回声斑块 (2 6 3% )。 131例缺血性脑血管病患者中颈动脉狭窄的发生率为 19 1% ,以中、重度狭窄为主 (80 % ) ,狭窄部位以颈总动脉为主 (4 3 3% ) ,其次为颈内动脉 (4 0 % )。缺血性脑血管病组颈动脉搏动指数、阻力指数及ICA/CCA比值较对照组高 (P <0 0 5 )。结论　颈动脉超声检查能确定缺血性脑血管病患者颈动脉粥样斑块的性质、稳定性 ,能确定颈动脉粥样硬化及颈动脉狭窄的程度 ,并提供颈动脉血流动力学参数 ,为动脉粥样硬化的早期预防和治疗提供客观的依据。     

Fabrication of a Mood vessel scaffold with a combined polymer for tissue enginerring

Objective To investigate the possibility to fabricate a blood vessel scaffold with a combined polymer for tissue engineering. Methods A blood vessel scaffold was designed with a combined polymer composed of rabbit vascular smooth muscle cells ( VSMCs), collagen and a non-spinning fabric mesh of polyglycolic acid(PGA). VSMQ were implanted into collagen gel and their growth was observed. The mixed solution of VSMQ and collagen was dropped into the tubular scaffold, followed by 7-day culturing. Results VSMQ formed many prominences after culturing in gelatinous collagen for 3 - 4 hours. With cells extending, some cells became shuttle-or spindle-shaped. After VSMQ-collagen complex was implanted into the PGA mesh, most of VSMCs remained in the pore of PGA mesh with the formation of gelation. VSMCs could adhere to and grow on the PGA fiber. Conclusion The non-spinning PGA porous biodegradable material coated with collagen is a good carrier for VSMCs to adhere and grow. 5 refs,3 figs.     

CT MAX-640故障检修3例

CT MAX-640为美国 GE公司所生产的经济普及型 CT,在中国及世界各地均有不俗的销量,该机型较具有代表性,所以笔者摘出几例检修实例,供同行参考.     

王国三治疗脱疽（血栓闭塞性静脉炎）用药特点

介绍国医大师王国三治疗脱疽热毒血瘀型用药特点。依据脱疽的病因病机，从其整体辨证论治，通过用药及药量的加减变化达到治疗目的。     

轮廓至上大脸变小脸

“大脸”怎么变“小脸”?尽管偶像艺人安以轩宣称“不必开刀”,每天唱10遍她的新歌《小脸进行曲》就能让爱美女孩拥有梦寐以求的“小脸”,但在美容外科医生眼中,脸部轮廓的修正可是大学问。